This is not a good post. I knew that as soon as I saw the title, because there are several different “retinoids” that are very different. Most of them have side effects and a mechanism of action that indicates negative long-term effects. Also some are teratogens. Maybe just read the wikipedia pages for the individual compounds.
The post specifically mentions adapalene which works by “increasing cell turnover” which long-term is presumably a bad thing. It also reduces “keratinocyte differentiation and decrease keratin deposition” which makes skin more fragile, and it increases sensitivity to UV light.
“not a good post” sounds kind of harsh and hostile to me, FWIW.
Leaving out major differences and understating risks is a big problem. But I personally had absolutely no idea that there was even a potential for anything to be remotely this effective for skincare, with or without risks.
Thus, this post is highly valuable for me; and of course I’d do a little research before embarking on something this time-consuming and expensive (daily time cost isn’t the right way to think about it; 10 minutes per day is about 60 hours per year, a week and a half of “full time” work devoted to looking younger every year)
I would prefer the author edit the post to say “there are differences and risks with each, do your due diligence and report back if you want”. But I am still upvoting the post for giving me one solid rationalist clue about the massively complex world of skincare claims.
“not a good post” sounds kind of harsh and hostile to me, FWIW.
OK, how about this then:
I have certain standards for giving many people strongly-worded medical advice, and this post is not even close to meeting them. It tells people to do something they most likely shouldn’t, based on brief and shallow research, and provides incomplete information. As such, I consider it unethical and it calls the judgement of the author into question in general.
Is that better?
If the post was just like, “hey, retinoids exist, if you have specific skin issues X or Y (keratosis pilaris, etc) you should consider them, especially the 3rd-generation ones like adapalene, note these side effects and check these articles and then maybe talk to your doctor”—that would be a good post. This is not.
IMO, I am not a huge fan of increasing the burden of evidence for medical claims one way or another. If the author believes that all things considered it’s better for most people to use a retinoid, then I think the post title seems good. If the author doesn’t believe that, then the title would be bad.
I don’t think you improve people’s decision-making in higher-stakes domains by reducing the amount of conversation and information sharing that happens around those topics (though it seems to be a common attractor in norm-space, which I find frustrating, and in as much as I get to set culture on LessWrong about how to handle topics that are often treated this way, I want to put an explicit flag up around “no, it’s fine to openly share advice about high-stakes domains, indeed we probably want to subsidize information sharing about high-stakes domains”).
I asked my dermatologist about skincare routines, and she said, approximately, “There is a cheap, widely available, extremely effective treatment for skin aging that has been around for decades”
Yeah, actually that sounds way better to me. It’s not only nicer but more informative. You really think people shouldn’t be using retinoids, based on your read (it’s more than mine) of the literature?
I really think most people shouldn’t be using retinoids, especially not “retinoids in general”. For people who have certain skin problems, certain retinoids can be worthwhile, but it’s up to them if the side effects are worth the potential (mainly aesthetic) benefits.
I certainly wouldn’t recommend “retinoids”—I’d talk about individual compounds.
My skin is starting to have the problem of looking way older than I’d like :) At the cost of sounding shallow, looks matter for a variety of purposes, so I’d take some measured risks and downsides to get the massive improvements shown in the photos here. I’ll do some research if I get around to it before the singularity :) and report it in a comment on this post if I do anything worthwhile.
I somehow doubt anyone is going to read this and immediately slather a mixture of every retinoid known to man directly to their face (including many which are only available by prescription). If they did, I honestly wouldn’t blame this post. They’re going to either go to a doctor to find out more about prescription treatments, or Google “retinoid cream” and find some over-the-counter retinol that’s safe and has no substantial side effects for most people. This is a perfectly OK introductory post.
I’ve read the article and notice that all the negative side-effects listed are due to issues with oral Retinoids rather than topical Retinoids.
Several of the articles I’ve read indicate that topical retinoids actually DECREASE the risk of cancer, though I agree this is confusing since they supposedly increase cell turnover rates, which should theoretically cause more mitosis-induced mutations to occur. But Retinoids are actually frequently used as anti-cancer drugs.
Google’s AI summarizer says you the mechanism of action is promotion of cell differentiation and inhibiting the progression of pre-malignant cells to malignant cells.
It also reduces “keratinocyte differentiation and decrease keratin deposition” which makes skin more fragile, and it increases sensitivity to UV light.
This is correct of course and why I specifically recommend in the post that people wear sunscreen when using retinoids.
I’ve read the article and notice that all the negative side-effects listed are due to issues with oral Retinoids rather than topical Retinoids.
No. Topical adapalene has side effects. Also, not sure why you’re capitalizing retinoids.
But Retinoids are actually frequently used as anti-cancer drugs
Anti-cancer drugs generally increase the risk of developing cancer. Cancer preventing compounds reduce the risk of developing cancer.
This is correct of course and why I specifically recommend in the post that people wear sunscreen when using retinoids.
Most sunscreens contain compounds that absorb UV by breaking into radicals, which can then cause problems in cells. They also often contain endocrine disruptors. These aren’t unavoidable issues but they are common. Sunscreen is also somewhat inconvenient.
No. Topical adapalene has side effects. Also, not sure why you’re capitalizing retinoids.
I just checked 5 of the individual wiki pages linked from the retinoid page. You suggest they have side effects (together with their mechanisms of action) that “[indicate] negative long-term effects”.
None of the linked pages’ listed topical side effects indicated that to me. Here is the section on side effects for adapalene:
Of the three topical retinoids, adapalene is often regarded as the best tolerated. It can cause mild adverse effects such as photosensitivity, irritation, redness, dryness, itching, and burning, and 1% to 10% of users experience a brief sensation of warmth or stinging, as well as dry skin, peeling and redness during the first two to four weeks using the medication. These effects are considered mild and usually decrease over time. Serious allergic reactions are rare.
Pregnancy & lactation
Use of topical adapalene in pregnancy has not been well studied but has a theoretical risk of retinoid embryopathy. Thus far, there is no evidence that the cream causes problems in the baby if used during pregnancy. Use is at the consumer’s own risk.
Topical adapalene has poor systemic absorption and results in low blood levels (less than 0.025 mcg/L) even after long term use, suggesting that there is low risk of harm for a nursing infant. However, it is recommended that the topical medication should not be applied to the nipple or any other area that may come into direct contact with the infant’s skin.
What in here indicates negative long-term effects?
And the mechanism involves increased cell turnover, which long-term tends to either increase stem cell depletion or increase cancer risk. There’s a tradeoff, which is why people don’t just do the thing normally. Maybe your natural tradeoff is wrong and you want to adjust it, but you have to recognize that it exists.
Can you link to a source about the increased cancer risk? Every source I’ve seen on this subject indicates retinoids DECREASE cancer risk, though I agree with you that this doesn’t make much intuitive sense.
This is not a good post. I knew that as soon as I saw the title, because there are several different “retinoids” that are very different. Most of them have side effects and a mechanism of action that indicates negative long-term effects. Also some are teratogens. Maybe just read the wikipedia pages for the individual compounds.
The post specifically mentions adapalene which works by “increasing cell turnover” which long-term is presumably a bad thing. It also reduces “keratinocyte differentiation and decrease keratin deposition” which makes skin more fragile, and it increases sensitivity to UV light.
“not a good post” sounds kind of harsh and hostile to me, FWIW.
Leaving out major differences and understating risks is a big problem. But I personally had absolutely no idea that there was even a potential for anything to be remotely this effective for skincare, with or without risks.
Thus, this post is highly valuable for me; and of course I’d do a little research before embarking on something this time-consuming and expensive (daily time cost isn’t the right way to think about it; 10 minutes per day is about 60 hours per year, a week and a half of “full time” work devoted to looking younger every year)
I would prefer the author edit the post to say “there are differences and risks with each, do your due diligence and report back if you want”. But I am still upvoting the post for giving me one solid rationalist clue about the massively complex world of skincare claims.
OK, how about this then:
Is that better?
If the post was just like, “hey, retinoids exist, if you have specific skin issues X or Y (keratosis pilaris, etc) you should consider them, especially the 3rd-generation ones like adapalene, note these side effects and check these articles and then maybe talk to your doctor”—that would be a good post. This is not.
IMO, I am not a huge fan of increasing the burden of evidence for medical claims one way or another. If the author believes that all things considered it’s better for most people to use a retinoid, then I think the post title seems good. If the author doesn’t believe that, then the title would be bad.
I don’t think you improve people’s decision-making in higher-stakes domains by reducing the amount of conversation and information sharing that happens around those topics (though it seems to be a common attractor in norm-space, which I find frustrating, and in as much as I get to set culture on LessWrong about how to handle topics that are often treated this way, I want to put an explicit flag up around “no, it’s fine to openly share advice about high-stakes domains, indeed we probably want to subsidize information sharing about high-stakes domains”).
I asked my dermatologist about skincare routines, and she said, approximately, “There is a cheap, widely available, extremely effective treatment for skin aging that has been around for decades”
Yeah, actually that sounds way better to me. It’s not only nicer but more informative. You really think people shouldn’t be using retinoids, based on your read (it’s more than mine) of the literature?
I really think most people shouldn’t be using retinoids, especially not “retinoids in general”. For people who have certain skin problems, certain retinoids can be worthwhile, but it’s up to them if the side effects are worth the potential (mainly aesthetic) benefits.
I certainly wouldn’t recommend “retinoids”—I’d talk about individual compounds.
My skin is starting to have the problem of looking way older than I’d like :) At the cost of sounding shallow, looks matter for a variety of purposes, so I’d take some measured risks and downsides to get the massive improvements shown in the photos here. I’ll do some research if I get around to it before the singularity :) and report it in a comment on this post if I do anything worthwhile.
Understandable, have a nice day.
I somehow doubt anyone is going to read this and immediately slather a mixture of every retinoid known to man directly to their face (including many which are only available by prescription). If they did, I honestly wouldn’t blame this post. They’re going to either go to a doctor to find out more about prescription treatments, or Google “retinoid cream” and find some over-the-counter retinol that’s safe and has no substantial side effects for most people. This is a perfectly OK introductory post.
I’ve read the article and notice that all the negative side-effects listed are due to issues with oral Retinoids rather than topical Retinoids.
Several of the articles I’ve read indicate that topical retinoids actually DECREASE the risk of cancer, though I agree this is confusing since they supposedly increase cell turnover rates, which should theoretically cause more mitosis-induced mutations to occur. But Retinoids are actually frequently used as anti-cancer drugs.
Google’s AI summarizer says you the mechanism of action is promotion of cell differentiation and inhibiting the progression of pre-malignant cells to malignant cells.
This is correct of course and why I specifically recommend in the post that people wear sunscreen when using retinoids.
No. Topical adapalene has side effects. Also, not sure why you’re capitalizing retinoids.
Anti-cancer drugs generally increase the risk of developing cancer. Cancer preventing compounds reduce the risk of developing cancer.
Most sunscreens contain compounds that absorb UV by breaking into radicals, which can then cause problems in cells. They also often contain endocrine disruptors. These aren’t unavoidable issues but they are common. Sunscreen is also somewhat inconvenient.
I just checked 5 of the individual wiki pages linked from the retinoid page. You suggest they have side effects (together with their mechanisms of action) that “[indicate] negative long-term effects”.
None of the linked pages’ listed topical side effects indicated that to me. Here is the section on side effects for adapalene:
What in here indicates negative long-term effects?
Adapalene is used topically. Wikipedia doesn’t list skin fragility as a side effect but—as you can guess from its mechanism—it is one.
And the mechanism involves increased cell turnover, which long-term tends to either increase stem cell depletion or increase cancer risk. There’s a tradeoff, which is why people don’t just do the thing normally. Maybe your natural tradeoff is wrong and you want to adjust it, but you have to recognize that it exists.
Can you link to a source about the increased cancer risk? Every source I’ve seen on this subject indicates retinoids DECREASE cancer risk, though I agree with you that this doesn’t make much intuitive sense.
Highlighting the existence of different retinoids is good. I have used retinol serums and a tretinoin cream (not at the same time). Retinol products are the most popular in the retinoid skincare category, and are sold over the counter, so reading specifically about them might be worthwhile.